Specialty Pharmacy Insights

This opinion article featured in The Hill is authored by Rebecca Shanahan, CEO of Avella Specialty Pharmacy and President of the National Association of Specialty Pharmacy (NASP).

Medicare was created in 1966 as a promise to protect our seniors. But the security of aging Americans is increasingly threatened.

Here’s how Medicare Part D is supposed to work: seniors go to the pharmacy of their choosing, exchange their co-pay for medications, and pay a monthly premium toward a Part D insurance plan that is administered by a pharmacy benefit manager (PBM). Unfortunately, big PBMs — the private insurers who sell Medicare Part D plans to seniors — are rigging the system by imposing unfair “direct and indirect remuneration fees,” or DIR fees.

With these DIR fees, PBMs are setting higher upfront prices on prescription drugs – which take larger and larger chunks of cash out of seniors’ pockets. If seniors are not careful, extra fees and higher costs can push them straight into Medicare’s “donut hole,” where they become solely responsible for 100 percent of the costs of the medications upon which they depend.

When seniors get sick, they visit their general practitioner to understand what’s happening with their health, and they are often referred to a specialist to confirm their diagnosis and treat their diseases in a way that addresses their unique needs. Specialty pharmacies are the pharmacy version of being referred to a medical specialist — seniors and their doctors call specialty pharmacies when the complexity of a disease requires more than just a prescription refill.

Specialty pharmacies support seniors struggling with complex, rare, life-threatening or life-changing diseases — including expensive medications to battle cancer, multiple sclerosis, HIV/AIDS, Crohn’s, or Hepatitis C — to make sure they understand their diagnosis, have access to innovative medications, and adhere to each prescription’s instructions. Specialty pharmacies provide seniors with high-touch clinical support throughout what is often months of prescription treatment to ensure they achieve the best medical outcomes.